Healthcare Provider Details

I. General information

NPI: 1235634064
Provider Name (Legal Business Name): EMILY DIANE HOGANCAMP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VERSAILLES RD
LEXINGTON KY
40504-1405
US

IV. Provider business mailing address

740 S LIMESTONE SUITE E101
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-3573
  • Fax: 859-323-0096
Mailing address:
  • Phone: 859-257-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberTP568
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberR4739
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number58294
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: